Provider Demographics
NPI:1437303005
Name:HANSON, JENNIFER ROSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ROSE
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3525
Mailing Address - Country:US
Mailing Address - Phone:608-698-5634
Mailing Address - Fax:
Practice Address - Street 1:1053 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3525
Practice Address - Country:US
Practice Address - Phone:608-698-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11382104100000X
WI127646-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker